A strange-bedfellows coalition of five patient-survey vendors last week launched an all-out entreaty for lobbying support from their healthcare clients to alter the size and approach of a proposed CMS survey, criticizing the 32-question instrument as burdensome and disruptive to ongoing hospital quality improvement efforts.
The American Hospital Association, a principal in the government survey initiative and a target of the lobbying effort, appealed for calm and cooperation from the vendors and scheduled a Jan. 29 meeting to discuss their concerns.
The last-ditch alliance demonstrated the urgency of the matter for a business characterized by "enormous competition," said AHA spokesman Richard Wade. "They're coming together so they can still come out and compete with each other."
The questionnaire in question, developed and field-tested during the past year by HHS' Agency for Healthcare Research and Quality, is the basis for a voluntary initiative worked out between the CMS and hospital groups, including the AHA, to help consumers make better choices about where to go for the best care (July 7, 2003, p. 4).
But the vendor group, in a letter to hospital executives and supporting information mailed last week, complained that the survey would divert resources and the attention of targeted patients from the surveys they already market, duplicating effort and possibly diluting the validity of both.
The vendors urged hospital executives to write the CMS and the AHA to support an alternative in which a total of five or six questions considered most important to patients could be embedded into the survey instruments already used for internal quality improvement purposes. A public comment period on the proposed survey ends Feb. 5.
Conspicuously missing from the vendor group was National Research Corp., also known as NRC/Picker, which went on record supporting the direction of the CMS survey instrument.
"We think the work the AHRQ has done is well-founded and based on good science," said NRC/Picker President Mike Hays. "We're suggesting the process they went through to create the instrument has a great amount of rigor to it."
The offensive launched by the other vendors was the latest in a series of maneuvers that have swirled around the patient-survey issue since it was proposed by the CMS a year ago as part of a larger project to report hospital performance to consumers (Feb. 10, 2003, p. 8).
A priority project for then-Administrator Tom Scully, it originally was supposed to become a mandatory condition of Medicare participation. But instead of issuing proposed regulations by June 2003 as planned, the CMS under pressure from the hospital lobby agreed to make participation voluntary.
Next it was the vendors' turn to argue for what to include in the patient questionnaire and how to make it compatible with their own surveys. The AHA first met with seven competing firms last July to solicit their comments, at which all but NRC/Picker pushed for no more than eight questions.
But when project researchers asked consumers what they thought, they wanted more information than could be gathered from the limited size suggested by industry vendors, a CMS official involved in the project said on condition of anonymity.
"The vendors' interest is to understandably keep the items for public reporting down" so they can preserve their own survey models, the official said.
The two objectives of the government-backed developers were to create a design that can be integrated into current commercial surveys but also to create a fair and meaningful comparison for consumers, which are "not entirely compatible," he said. "We tried to strike an appropriate balance."
After a call for measures, the AHRQ compiled a list of 68 questions to test in three states-Arizona, Maryland and New York-that also are piloting a companion project to report hospital performance on 10 measures of clinical quality. The testing also included focus groups of consumers.
That effort weeded out more than half the original number of questions and organized the rest into areas of doctor and nurse communication, experiences in the hospital, arrangements when leaving, overall rating and patient characteristics.
"This is our best shot," the official said, but added, "If people disagree, we want to hear from them."
The vendor coalition appealed to hospital executives to do just that. "This will most likely be your last opportunity to shape this federal initiative," the group's letter warned in boldface type. "Immediately request, in a brief letter, that CMS further reduce the number of (proposed survey) questions to six or less and that AHA work toward that objective."
Melvin Hall, president and chief executive officer of Press Ganey, said the hospital survey processes already in place meet the objectives of public reporting, and a small number of standard questions across all survey instruments could satisfy the objective of government accountability.
The letter also estimated that for the extra data collection alone, the government survey "will siphon $160 million to $200 million directly from the nation's hospitals" during the next five years. Hall said the estimate assumed an average annual cost of about $6,000 for 5,000 hospitals.
But the AHA's Wade said it was time for vendors to help hospitals comply with "enormous pressure" to satisfy demands for performance data. Hospital executives are being caught in the middle and "whipsawed" by competing interests of the government, hospital associations and their vendors, he said.
Wade urged vendors to consider building new products to meet the aim of public reporting instead of being concerned that they won't be able to offer a distinct product.
For all the good that the various patient-survey products have done within hospitals, none were ever intended to reach the public-and that has to change, he said. "Public accountability is not going to be an option for our members. It's going to be a fact of life, one way or another," he said.